Comparison of surgical outcomes of sleep surgeries preoperatively evaluated with drug-induced sleep endoscopy and Müller's maneuver.

Objective The purpose of this study was to compare surgical outcomes for obstructive sleep apnea (OSA) when the procedure was based on the results of drug-induced sleep endoscopy (DISE) vs. the awake Müller's maneuver (MM). Methods Forty-seven patients with OSA who underwent sleep surgery were included. Patients were divided into 2 groups according to their preoperative upper airway evaluation method. Twenty-five patients received only MM for surgical decision making (MM group), and 22 patients received both MM and DISE (DISE group) for surgical decision making. Results The surgical success rate of the DISE group was higher than that of the MM group (59% vs. 36%), but the difference was not significant (p = 0.118). The differences between pre- and postoperative apnea-hypopnea index (AHI) values in both the MM and DISE group were highly significantly different (p < 0.001). Fifteen patients in the DISE group (68.2%) received multi-level surgery, while in the MM group only 7 patients (28%) received multi-level surgery. Patients with more severe OSA (AHI > 22 or lowest O2 saturation < 81%) had better surgical outcomes when their surgical procedures were based on the findings of DISE, rather than those of MM. Conclusion The results indicate that DISE provides no benefits with respect to surgical outcomes for patients with mild to moderate OSA; however, for patients with more severe OSA surgical procedures based on DISE result in better outcomes.

Anti-inflammatory effects of Perilla frutescens in activated human neutrophils through two independent pathways: Src family kinases and Calcium.

The leaves of Perilla frutescens (L.) Britt. have been traditionally used as an herbal medicine in East Asian countries to treat a variety diseases. In this present study, we investigated the inhibitory effects of P. frutescens extract (PFE) on N-formyl-Met-Leu-Phe (fMLF)-stimulated human neutrophils and the underlying mechanisms. PFE (1, 3, and 10 µg/ml) inhibited superoxide anion production, elastase release, reactive oxygen species formation, CD11b expression, and cell migration in fMLF-activated human neutrophils in dose-dependent manners. PFE inhibited fMLF-induced phosphorylation of the Src family kinases (SFKs), Src (Tyr416) and Lyn (Tyr396), and reduced their enzymatic activities. Both PFE and PP2 (a selective inhibitor of SFKs) reduced the phosphorylation of Burton's tyrosine kinases (Tyr223) and Vav (Tyr174) in fMLF-activated human neutrophils. Additionally, PFE decreased intracellular Ca(2+) levels ([Ca(2+)]i), whereas PP2 prolonged the time required for [Ca(2+)]i to return to its basal level. Our findings indicated that PFE effectively regulated the inflammatory activities of fMLF-activated human neutrophils. The anti-inflammatory effects of PFE on activated human neutrophils were mediated through two independent signaling pathways involving SFKs (Src and Lyn) and mobilization of intracellular Ca(2+).

Anesthetic management of a repeat cesarean section in a parturient with severe peripartum cardiomyopathy requiring ECMO in a previous pregnancy: a case report.

The number of pregnant women with cardiac disease is increasing with improvements in technology. In addition, more people are part of the national health insurance plan. However, there are few reports concerning the best method for anesthesia and mode of delivery in these high-risk patients. We report a 29-year-old woman scheduled for a planned caesarean section, who had a history of severe peripartum cardiomyopathy requiring extracorporeal membrane oxygenation in a previous pregnancy. The patient had regular prenatal care in our obstetric clinic. At 29 weeks' gestation, she developed severe dyspnea. A chest radiograph revealed bilateral pulmonary edema and 2-dimensional echocardiography showed a global hypokinesis and severe valve regurgitation with left ventricular ejection fraction of 41.2%. She had an emergency caesarean section and a cardiovascular surgeon was consulted to stand-by. Anesthesia was induced by ketamine 25 mg, midazolam 2.5 mg and rocuronium 50 mg for rapid intubation. The patient tolerated the procedure well and was extubated on postoperative day 1. She was discharged one week after surgery. Postoperatively, the patient was followed in the obstetric and cardiovascular surgery outpatient departments and at 5 months after surgery she was in good condition without any complaints.

Operation cancellation at Chang Gung Memorial Hospital.

BACKGROUND: Roughly 60,000 operations are performed at our medical center every year, so making efficient use of operating rooms (OR) is an important issue. Decreasing the cancellation rate of surgery is one method that could increase efficiency. We reviewed all OR cancellations in 2007 to survey the cancellation rates and causes. METHODS: The present study was retrospective. Data were collected from the Department of Anesthesiology Quality Assurance Database of Chang Gung Memorial Hospital. We analyzed medical records for cancellations from January 1 to December 31, 2007. Data were analyzed using SPSS 16.0, employing descriptive measures and logistic regression. RESULTS: There were 61855 operations scheduled during this period; 229 were cancelled (0.37%). The mean age of patients in the cancelled group was significantly higher than that in the the non-cancelled group. We found a positive correlation between the cancellation rate and American Society of Anesthesiologists physical status. Cancellations for outpatient surgery were most frequent, as were those in the ophthalmology department. Forty-seven cases were cancelled because of cardiovascular problems; 136 operations were done later after the original cancellation issues were addressed while 11 were done under local anesthesia. CONCLUSIONS: Of all causes of cancellation of surgery, 54.1% were avoidable. Medical teams must communicate better with patients and relatives, identify and treat relevant comorbidities, and make adequate preparations for surgery.